Acute Hospital Environment Research Articles

Contextual factors and intentional rounding in acute hospitals: understanding what works, for whom, in what settings: a realist synthesis protocol

Background This study aims to understand and explain the influence of contextual factors on the implementation of Intentional Rounding in acute hospitals using the realist synthesis methodology. Falls of hospital admitted patients are one of the most frequent concerns for patient safety in the acute hospital environment. The reasons why people fall are complex. International guidelines recommend a multifactorial assessment and effective prevention and management of identified risk factors in order to reduce the number of falls. Intentional Rounding (IR) is one approach for delivering this. IR is an umbrella term, understood as a structured process whereby nurses or care staff carry out regular checks with individual patients using a standardised protocol to address such issues as positioning, pain, personal needs and placement of possessions. Methods This study will use realist synthesis to understand what works, for whom, in what circumstances, and in what settings. Realist synthesis is a theory driven interpretive approach to evidence synthesis. It is our intention to analyse IR as an intervention, which aims to enhance patient care and safety in hospital settings. The synthesis forms part of a larger implementation study examining interventions that reduce the number of falls that occur in hospitals. Search terms will include intentional rounding, purposeful rounding, comfort rounding and hourly rounding and will encompass search terms beyond IR and falls rates to avoid limiting the synthesis. This synthesis will conform to the RAMESES (realist and meta-narrative evidence synthesis group) publication and reporting quality standards. Conclusions The findings will inform the next phase of an implementation study on IR in acute hospital settings, to address evidence informed enablers and barriers to IR. The results will be disseminated in a peer-reviewed journal and through presentations.

Contextual factors and intentional rounding in acute hospitals: understanding what works, for whom, in what settings: a realist synthesis protocol.

This study aims to understand and explain the influence of contextual factors on the implementation of Intentional Rounding in acute hospitals using the realist synthesis methodology.Falls of hospital admitted patients are one of the most frequent concerns for patient safety in the acute hospital environment. The reasons why people fall are complex. International guidelines recommend a multifactorial assessment and effective prevention and management of identified risk factors in order to reduce the number of falls. Intentional Rounding (IR) is one approach for delivering this. IR is an umbrella term, understood as a structured process whereby nurses or care staff carry out regular checks with individual patients using a standardised protocol to address such issues as positioning, pain, personal needs and placement of possessions. This study will use realist synthesis to understand what works, for whom, in what circumstances, and in what settings. Realist synthesis is a theory driven interpretive approach to evidence synthesis. It is our intention to analyse IR as an intervention, which aims to enhance patient care and safety in hospital settings. The synthesis forms part of a larger implementation study examining interventions that reduce the number of falls that occur in hospitals. Search terms will include intentional rounding, purposeful rounding, comfort rounding and hourly rounding and will encompass search terms beyond IR and falls rates to avoid limiting the synthesis. This synthesis will conform to the RAMESES (realist and meta-narrative evidence synthesis group) publication and reporting quality standards. The findings will inform the next phase of an implementation study on IR in acute hospital settings, to address evidence informed enablers and barriers to IR. The results will be disseminated in a peer-reviewed journal and through presentations.

'Alright my lovely': The use of terms of endearment as a mitigation device in the care of people living with dementia in the acute hospital environment.

This paper examines how terms of endearment (ToE) are used as a mitigation device in interactions between staff and people living with dementia (PLWD) in the acute hospital environment. ToE are often discouraged in training for healthcare staff. However, this research demonstrates that they are still commonly used in practice. Using conversation analysis, video and audio data were examined to identify the interactional functions of ToE. Analysis showed that ToE play an important role in mitigating potentially face-threatening actions such as when patients are asked to repeat hard-to-interpret talk, or when patient agency is compromised through instruction sequences or having necessary healthcare tasks undertaken. The success of this mitigation is sensitive to the specific interactional circumstances, as well as the responsiveness of the HCP to the patient's voiced concerns. These findings have implications for healthcare practice, training and wider care of PLWD.

Contextual factors and intentional rounding in acute hospitals: understanding what works, for whom, in what settings: a realist synthesis protocol

Background This study aims to understand and explain the influence of contextual factors on the implementation of Intentional Rounding in acute hospitals using the realist synthesis methodology. Falls of hospital admitted patients are one of the most frequent concerns for patient safety in the acute hospital environment. The reasons why people fall are complex. International guidelines recommend a multifactorial assessment and effective prevention and management of identified risk factors in order to reduce the number of falls. One approach for delivering this is by Intentional Rounding (IR). IR is an umbrella term, understood as a structured process whereby nurses or care staff carry out regular checks with individual patients using a standardised protocol to address such issues as positioning, pain, personal needs and placement of possessions. Methods This study will use realist synthesis to understand what works, for whom, in what circumstances and in what settings. Realist synthesis is a theory driven interpretive approach to evidence synthesis. It is the intention of the researchers to analyse IR as an intervention, which aims to enhance patient care and safety in hospital settings. The synthesis forms part of a larger implementation study examining interventions that reduce the number of falls that occur in hospitals. Search terms will include intentional rounding, purposeful rounding, comfort rounding and hourly rounding and will encompass search terms beyond IR and falls rates in order not to limit the synthesis. This synthesis will conform to the RAMESES (realist and meta-narrative evidence synthesis group) publication and reporting quality standards for a realist synthesis. Conclusions The findings will inform the next phase of an implementation study on IR in acute hospital settings, namely selection of an IR approach and evidence informed barriers and enablers to its implementation. The results will be disseminated in a peer-reviewed journal and through presentations.

Nurse manager support of graduate nurse development of work readiness: An integrative review.

To systematically review relevant literature to identify how Nurse Managers support graduate nurse work readiness. Graduate nurses face many difficulties when transitioning from student to qualified nurse. Nurse managers establish workplace culture through leadership styles, yet little is known about how they can best support graduate nurses to transition to professional practice in the acute hospital environment. A five-step, systematic integrative review reported in accordance with the PRISMA 2020 Checklist. The steps of the review method included (1) problem identification, (2) literature search, (3) data evaluation and quality appraisal, (4) data extraction and analysis and (5) presentation. Analysis used the Framework method and was guided by theory of graduate nurse work readiness and the Theoretical Domains Framework. MEDLINE COMPLETE, Cumulative Index to Nursing and Allied Health (CINAHL) Complete, ERIC and PSYCINFO searched in December 2020. Studies eligible for inclusion (N= 40) represented research from 15 countries; most (67.5%, n= 27) used a qualitative design, 22.5% (n= 9) were quantitative and 10% (n= 4) used mixed methods. Three themes related to the social constructs and local area work environments influenced by nurse managers emerged: supporting people, supportive environment and supporting learning. The review identified a lack of robust evidence about the effectiveness of specific nurse manager-led strategies to support development of graduate work readiness. However, the findings provide a framework to guide nurse managers in supporting graduate nurses and provide a foundation for further research about nurse manager roles in developing graduate work readiness. Previous research has described poor transition of graduate nurses as responsible for increased workplace errors, decreased job satisfaction and high rates of attrition. Exploring the role of nurse managers in graduate nurse transition is essential to ensure quality patient care and a sustainable workforce. What Problem Did the Study Address? Graduate nurses face many difficulties when transitioning from student to qualified nurse. Nurse managers establish workplace culture through leadership styles, yet little is known about how they can best support graduate nurses to transition to professional practice in the acute hospital environment. What Were the Main Findings? High rates of attrition are attributed to poor support during the initial transition phase of graduate nurses. Nurse managers can impact transition by providing a supportive environment, support learning and by providing a team of supportive people. Where and on whom will the research have an impact? The research will have an impact on graduate nurses and nurse managers. No patient or public contribution (integrative review exploring existing literature). This integrative review was registered with PROSPERO (CRD42021213142).

QI initiative to reduce the number of inpatient falls in an acute hospital Trust

Inpatient falls are one of the most frequent concerns to patient safety within the acute hospital environment, equating to 1700 falls per year in an 800-bed general hospital. They are...

Responsive Behaviors and Pain Management in Hospital Dementia Care: A Before and After Comparison of the "Serial Trial Intervention".

PurposeResponsive behavior, often referred to as behavioral and psychological symptoms of dementia (BPSD), is among the most critical disorders in dementia whereby nursing personnel in hospitals are increasingly confronted with such symptoms. The purpose was to reduce the level of BPSD in an acute hospital environment through a stepwise procedure followed by the initiation of a needs-oriented treatment.MethodsAn open, prospective, interventional study with before-after comparisons was used to implement “Serial Trial Intervention” (STI) in three hospital wards (internal medicine, surgery, geriatric) after its adaption for hospital setting which was supplemented with a detailed pain assessment. Participants were 65 years and older. Potential causes of BPSD were clarified in a stepwise procedure and, if possible, eliminated. The primary outcome was the reduction in BPSD measured by the Neuropsychiatric Inventory (NPI-Q-12) while secondary outcomes were through the use of non-pharmacological and pharmacological interventions.ResultsNo significant reduction in NPI-Q-12 could be found. However, significantly more mobilizations and changes of position were carried out. Higher antipsychotic use was seen in the after-groups presumably due to the higher rates of delirium and cognitive impairment. Furthermore, the data showed no increase in analgesic use.ConclusionNo significant reduction in NPI-Q-12 was observed in the before-after study. The use of antipsychotics even increased most probably due to a higher incidence of deliriousness in the after-group. However, STI seemed to improve attention to underlying causes of BPSD as well as pain. Proof that STI leads to NPI-Q-12 reduction in hospitals is still pending.

Understanding nurses’ perceptions of barriers and enablers to use of a new electronic medical record system in Australia: A qualitative study

BackgroundElectronic medical record system implementations impact nurses, their work and workflows. The aim of this study was to understand nurses’ perceptions of barriers and enablers to using a new electronic medical record in an acute hospital environment. MethodsData were collected just prior to an organisation-wide new electronic medical record implementation at a large tertiary healthcare organization in Victoria, Australia. Sixty-three nurses from five hospital sites participated in 12 focus group interviews. Transcripts were transcribed and deductive content analysis used the 14-domain Theoretical Domains Framework to identify barriers and enablers. ResultsCoded data mapped to 13 of the 14 domains. Nurse motivation emerged as a dominant theme among both barriers and enablers. Nurses’ most common perceived barriers related to emotions (24.1%) and environmental context and resources (21.3%). Conversely, the most common enablers related to social influences (21%) and reinforcement (20.8%). DiscussionIn addition to effecting changes in their work and workflows, the dominance of nurses’ emotional responses reveals the potential for implementation of a new electronic medical record to negatively affect nurses’ psychological well-being. Using data aligned to the Theoretical Domains Framework assisted identification of behavior change strategies to target the barriers and enablers perceived by nurses. Strategies aligned with nine behavioral intervention categories are recommended for successful implementation and optimization of an electronic medical record by nurses. ConclusionsMultifaceted strategies targeting multiple behaviors are required to support adoption of the electronic medical record by nurses, and reduce the risk for nurse attrition in the workforce.

Coming together to find meaningful solutions to reduce deconditioning in the clinical setting #ActiveWards

Purpose: Patients tell us they want to be more active during a hospital stay. In the acute hospital environment deconditioning is a major risk factor with around 90% of the day spent sitting/lying. As experts in activity and movement, a Physiotherapy and Occupational Therapy Active Wards Special Interest Group (SIG) was formed to provide peer support and act as a platform for sharing resources and ideas for increasing opportunities for physical activity in the in-patient setting and avoid duplication and allow change to be clinician-led.

Automation of Lung Ultrasound Interpretation via Deep Learning for the Classification of Normal versus Abnormal Lung Parenchyma: A Multicenter Study.

Lung ultrasound (LUS) is an accurate thoracic imaging technique distinguished by its handheld size, low-cost, and lack of radiation. User dependence and poor access to training have limited the impact and dissemination of LUS outside of acute care hospital environments. Automated interpretation of LUS using deep learning can overcome these barriers by increasing accuracy while allowing point-of-care use by non-experts. In this multicenter study, we seek to automate the clinically vital distinction between A line (normal parenchyma) and B line (abnormal parenchyma) on LUS by training a customized neural network using 272,891 labelled LUS images. After external validation on 23,393 frames, pragmatic clinical application at the clip level was performed on 1162 videos. The trained classifier demonstrated an area under the receiver operating curve (AUC) of 0.96 (±0.02) through 10-fold cross-validation on local frames and an AUC of 0.93 on the external validation dataset. Clip-level inference yielded sensitivities and specificities of 90% and 92% (local) and 83% and 82% (external), respectively, for detecting the B line pattern. This study demonstrates accurate deep-learning-enabled LUS interpretation between normal and abnormal lung parenchyma on ultrasound frames while rendering diagnostically important sensitivity and specificity at the video clip level.

Where are the children? An autoethnography of deception in dementia in an acute hospital.

An acute hospital environment is a confusing place for many patients requiring admission, especially when they are presenting as acutely unwell. This can be particularly difficult for people living with dementia. As cognition changes it is not uncommon for people living with dementia to have difficulties with their ability to orientate to time, place and person. These disorientating moments can lead to personal distress, and at times behavioural changes. As well as being distressing for the person living with dementia, it can also be emotionally and ethically challenging for acute hospital staff, including nurses. One area found to be particularly challenging is the concept of whether actively engaging with a person living with dementia's living truth is deceitful. This raises further questions of what forms of nurse responses to temporal disorientation might be constituted as lying, colluding, or alternatively validating. This article uses autoethnography as a research methodology with which to explore a mental health nurse's lived experience of the challenges of responding truthfully to disorientation and distress in an acute hospital. This article is not attempting to offer conclusive answers to these challenging ethical questions. It is instead re-opening and re-visiting the discourse of what is truth in dementia from a personal and professional nurse perspective through a lived narrative. The conclusion to the concept of truth in dementia is complex, nuanced and individualized. However, it is essential that a nurse's response to disorientation and distress is always person and living present focused, and not lie focused.

Family caregivers' experiences of end-of-life care in the acute hospital setting. A qualitative study.

BackgroundAcute hospital settings are generally not considered adequate places for end‐of‐life care, but terminally ill patients will continue to die in acute medical wards in the unforeseeable future.AimThe aim of this study was to investigate family caregivers’ experiences of end‐of‐life care in an acute community hospital in Iceland.MethodsFifteen in‐depth qualitative semi‐structured interviews were conducted with participants who had been primary caregivers. The transcribed interviews were analysed using thematic content analysis.FindingsFindings indicated that the acute hospital setting is not a suitable environment for end‐of‐life care. Effective communication and management of symptoms characterised by warmth and security give a sense of resilience. Three main themes emerged: (1) Environmental influences on quality of care; (2) Communication in end‐of‐life care; (3) The dying process. Each of the themes encompassed a variety of subthemes.ConclusionsFindings suggest that effective communication is the cornerstone of quality of care in the acute hospital environment and essential for establishing a sense of security. The severity of symptoms can deeply affect family caregivers’ well‐being. Acknowledging and appreciating the meaning of respect and dignity at the end‐of‐life from family caregivers’ perspective is vital.

Clinical sympathy – A mixed method study of the relationship between the clinical nurse educator and the graduate nurse

Aim/ObjectiveThis paper sought to investigate the influence of the supernumerary clinical nurse educator role on the newly qualified graduate nurses’ professional development and successful transition to competent and confident practitioners in the acute care hospital environment. BackgroundThe novice nurses learning in the inpatient clinical environment is affected by increasing patient acuity, complex conditions and organisational expectations. The supernumerary clinical nurse educator is uniquely positioned to prioritise these nurses’ education through protected and available time to support adaption in the workplace culture and retention in the organisation. DesignA convergent mixed methods design was used to investigate the relationship between the supernumerary clinical nurse educator role through the opinions and experiences of the graduate nurse. MethodsData were collected in February - July 2015 from graduate nurses from three hospital sites in a healthcare organisation in Western Australia. The research used online questionnaires (n = 39) and face to face interviews (n = 10). Analysis of quantitative data used descriptive statistics and qualitative data used thematic analysis. ResultsFour main themes were identified. These were: acknowledges new and challenging experiences, available to provide constructive responses, sympathises with anxiety and missing in action. ConclusionThe graduate registered nurses perceived that clinical sympathy provided by the clinical nurse educator was essential to their new role of frontline nurses influencing their delivery of quality patient care and as a practical solution to champion the graduate nurses’ longevity in the future nursing workforce.

Evaluating the co-production of active ward principles in an inpatient setting: staff developments from using person-centred practice developmen

Background: In the acute hospital environment deconditioning is a major risk factor, with around 90% of the day spent sitting or lying down. A physiotherapy and occupational therapy Active Wards Special Interest Group was formed to provide peer support and act as a platform for sharing resources and ideas to increase opportunities for physical activity in the inpatient setting. Drawing on the nine principles of Practice Development, a person-centred, participatory approach was adopted. These values promote time and space for the team to grow and develop together, accounting for best evidence, personal and professional experience. The group co-produced a toolbox of resources, active wards principles and formed a group of experts to help others. Aim: To evaluate the experience of staff engaging in this work with the objective of learning from the experience and make recommendations for replication and continuation of the improvement process. Methods: Members of the special interest group and their team leads were invited to complete an online self-reporting questionnaire defining their experiences of participating in the group. Results: Engaging clinicians in improvement through person-centred practice development processes delivers benefits for patients, services and clinicians. Key findings for staff development were identified as significantly improved (response rate of 78%) through i) active learning principles used for meetings, ii) effective and diverse communication strategies, and iii) group cohesion by engaging in a practice-based initiative. Group members and team leads observed personal, professional and service development. Participants made new connections, had a sense of a common vision and felt part of a collaborative process where ideas and feedback were shared. Where changes in patient activity levels had been observed, at least two-thirds of teams attributed this to having a team member in the group. Conclusions and implications for practice: Clinicians require adequate time, space and support to achieve improvements When engaged with active learning and participatory approaches, clinicians make better use of meetings to develop and form principles of practice relevant to their clinical context and patient groups Engaging in person-centred practice development processes enables clinicians to develop transferable skills Practice development methods can be readily replicated for initiating and engaging clinicians in other practice-driven development projects

Nurses' experiences of caring for persons with dementia experiencing responsive behaviours in an acute hospital: A qualitative descriptive study.

To explore nurses' experiences of caring for persons with dementia experiencing responsive behaviours in an acute hospital. Caring for persons with dementia who have an acute medical illness and are experiencing responsive behaviours in acute hospitals can be challenging for nurses. While existing research has explored the experiences of nurses in providing dementia care in this setting, there is limited knowledge about the specific care experiences of nurses when working to meet the needs of persons with dementia who experience responsive behaviours alongside an admitting diagnosis. A qualitative descriptive design was implemented. Semi-structured interviews were carried out with nine nurses working in medical and surgical wards. A thematic analysis approach was used to analyse the data. Ethical approval to conduct the study was received from the writers' university. Three themes were found: (a) challenges encountered, (b) a person-centred response and (c) dementia preparedness. Key findings about challenges encountered by nurses included: the acute hospital environment; increased need for enhanced knowledge; and emotional challenges. Person-centred responses such as working in partnership with others and reminiscence were identified as strategies to address the challenges. Finally, nurses identified particular interventions that were supportive to them in enhancing their preparedness to meet the needs of persons with dementia who experience responsive behaviours. Persons with dementia who are acutely unwell and are experiencing responsive behaviours, within acute hospitals, have specific and individualised care needs. Nurses working in these settings must therefore be supported in developing competence in managing these frequently complex clinical cases, while also providing person-centred care. Nurses' narratives demonstrate that they continue to experience challenges in the presence of responsive behaviours. There is a consequent need for dementia-specific education on person-centred ways to address responsive behaviours within acute hospital settings.

“The little lights in this dark tunnel”: Emotional support of nurses working in COVID-19 acute care hospital environments

Background: Working on the frontlines of hospitals during the COVID-19 pandemic has been challenging and distressing for nurses. The troublesome nature of these emotions have surfaced because of uncharted territory related to this virus, compromised work conditions, unfavourable patient outcomes, and the witnessing of suffering and loss. Although there has been renewed emphasis on how to emotionally support nurses, the nature of support needed is somewhat unknown considering that healthcare professionals have not experienced a pandemic of this magnitude in their lifetime. Aim: We explored how nurses were emotionally supported and how they can be better supported while working in COVID-19 acute care hospital environments. Methods: In this narrative study, semi-structured interviews were conducted with 20 registered nurses working in hospitals in the Greater Toronto Area and working on units caring for COVID-19+ patients. Results and Conclusions: Our findings reflected the organic emergence of support, intentional forms of support, and the social justice nature of support. It is important for hospital and government leaders to employ a multifold approach to emotionally support nurses. These supports include information transparency, visible presence of leadership, and recognition of nurses’ contributions. While emotionally supporting nurses, these types of resources can act as “little lights in this dark tunnel” of COVID-19 and illuminate a path forward. Implications: Some strategies relevant to clinical practice include regular rounding of units by leaders, and transparent communication about information and resources. Other strategies are on-site psychological support and legitimate support of mental health sick days as well as lobbying governments for financial compensation for the risky work involved in being a frontline provider and appropriate provision of personal protective equipment.

Psychological needs of patients attending a post Covid-19 multidisciplinary clinic

This paper reports on a post Covid-19 clinic within an acute hospital environment. Of the 155 patients who attended clinic, 29 per cent required additional psychological support. We outline the psychological wellbeing and psychological care pathways identified for patients. © 2021, British Psychological Society. All rights reserved.

"Goodbye … Through a Glass Door": Emotional Experiences of Working in COVID-19 Acute Care Hospital Environments.

BackgroundThe severity of the COVID-19 health crisis has placed acute care nurses in dire work environments in which they have had to deal with uncertainty, loss, and death on a constant basis. It is necessary to gain a better understanding of nurses’ experiences to develop interventions supportive of their emotional well-being.PurposeThe purpose of this study is to explore how nurses are emotionally affected working in COVID-19 acute care hospital environments. The research question is: What is the emotional experience of nurses working in COVID-19 acute care hospital environments?MethodsWe employed a narrative methodology that focused on participants’ stories. Twenty registered nurses, who worked in six hospitals in the Greater Toronto Area in Canada, participated in interviews. A narrative analysis was conducted with a focus on content and form of stories.ResultsWe identified three themes about working in COVID-19 acute care hospital environments: the emotional experience, the agency of emotions, and how emotions shape nursing and practice.ConclusionIn moving forth with pandemic preparations, healthcare leaders and governments need to make sure that a nurse’s sacrifice is not all-encompassing. Supporting nurses’ emotional well-being and resilience is necessary to counterbalance the loss and trauma nurses go through.

A protocol for a qualitative synthesis exploring people with stroke, family members, caregivers and healthcare professionals experiences of early supported discharge (ESD) after stroke

Early supported discharge (ESD) facilitates a person with a stroke to be discharged from the acute hospital environment earlier than conventional care to continue their rehabilitation within the home with members of the multi-disciplinary team. A number of quantitative studies have highlighted benefits of ESD including a reduction in the length of inpatient stay, cost savings, as well as reducing long term dependency. This systematic review and qualitative synthesis explores the perspectives and experiences of those involved in ESD including people with stroke, family members, caregivers as well as the healthcare professionals involved in the delivery of the service. A comprehensive literature search will be completed in the following databases CINAHL, PubMed Central, Embase, Medline, PsycINFO, Sage, Academic Search Complete, Directory of Open Access Journals, The Cochrane Library, PsycARTICLES and Scopus. Qualitative or mixed methods studies that include qualitative data on the perspectives and experiences of people with stroke, family members, caregivers and healthcare professionals of an ESD service will be included. Methodological quality will be appraised using the ten-item Critical Appraisal Skills Programme checklist for qualitative research by two independent reviewers with a third reviewer involved should differences of opinion arise. Findings will be synthesised using thematic synthesis. It is anticipated that the qualitative synthesis will provide a deeper understanding of the experiences of ESD which may serve to inform practice as well as assist in the development of new ESD services. PROSPERO registration: CRD42020135197 – 28/04/2020

Exploring the communication experiences of stroke nurses and patients with aphasia in an acute stroke unit

ABSTRACT Aim The purpose of this qualitative study was to investigate the perceptions of stroke nurses and patients with aphasia on their experiences of communicating in an acute stroke hospital unit. Method Five stroke nurses and six patients with aphasia participated in this study. The nurses participated in a focus group and the patients participated in one-on-one interviews. The focus group and interviews were semi-structured and elicited information from participants about potential facilitators and barriers to successful communication in the acute unit. The focus group and interviews were recorded and transcribed. Thematic analysis was used to analyze the data. Results Analysis of the interview transcripts generated five key themes. Theme one, two and three represented perspectives of both nurses and patients with aphasia. Theme four was represented by patients only and theme by nurses only. Themes reflected: (1) the frustration experienced by nurses and patients with aphasia when communicating; (2) the perceptions of nurses and patients with aphasia on the use of communication supports; (3) the beliefs on what healthcare information needs to be shared between nurses and patients with aphasia; (4) the excellent care provided by nurses to patients with aphasia; and (5) the positive attitude of nurses when communicating with people with aphasia. Conclusions Stroke nurses and patients with aphasia experience difficulty communicating. These findings suggest that specific strategies, such as tailored Communication Partner Training (CPT) for nurses and centralised nurse access to a range of communication aids and resources, might contribute to the formation of a more communicatively accessible acute hospital environment for patients with aphasia.